<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>IIET Payments Form</title>
<script type="text/javascript" src="jquery.js"></script>
<script type="text/javascript">
	function setFees() {
		$("#tution_fee").val('0');
		$("#admission_fee").val('0');
		$("#hostel_fee").val('0');
		$("#transport_fee").val('0');
		$("#paid_by").val('');

	}
</script>
</head>


<body onload="setFees();">

<h1 align="center"> Payments Form</h1> 

<form id="form1" name="form1" method="post" action="savepayment.htm">
  <p>&nbsp;</p>
  <table width="300" border="1" align="center" cellpadding="5" >
    <caption>
      Payment Information
    </caption>
    <tr>
      <td  align="right">Receipt No:</td>
      <td><label>
        <input name="receipt_number" type="text" id="receipt_number" size="20" />
      </label></td>
    </tr>
    <tr>
      <td align="right">Hallticket No:</td>
      <td><label>
        <input name="htno" type="text" id="htno" size="20" />
      </label></td>
    </tr>
    <tr>
      <td align="right">Year of Study:</td>
      <td><select name="year">
<option value="I">I Year</option>
<option value="II">II Year</option>
<option value="III">III Year</option>
<option value="IV">IV Year</option>
</select>

</td>
    </tr>
    <tr>
      <td align="right">Tution Fee:</td>
      <td><label>
        <input name="tution_fee" type="text" id="tution_fee" size="20" />
      </label></td>
    </tr>
    <tr>
      <td align="right">Admission Fee:</td>
      <td><label>
        <input name="admission_fee" type="text" id="admission_fee" size="20" />
      </label></td>
    </tr>
    <tr>
      <td align="right">Hostel Fee:</td>
      <td><input name="hostel_fee" type="text" id="hostel_fee" size="20" /></td>
    </tr>
    <tr>
      <td align="right">Transport Fee:</td>
      <td><input name="transport_fee" type="text" id="transport_fee" size="20" /></td>
    </tr>
    <tr>
      <td align="right">Paid by:</td>
      <td><label>
        <input name="paid_by" type="text" id="paid_by" size="20" />
      </label></td>
    </tr>
    <tr>
      <td colspan="2" align="center"><label>
        <input name="submit" type="submit" id="submit" value="Make Payment" />
      </label></td>
    </tr>
  </table>
</form>
</body>
</html>
